Soft skills in Orthodontics: an analysis in residents and experienced professionals

ABSTRACT Introduction: Soft skills represent a range of personal skills, attitudes and characteristics relevant to success and adequate work performance. Objective: This study aimed to evaluate the knowledge and usage of soft skills in Orthodontics. Methods: The participants answered a questionnaire containing 27 objective questions on awareness and frequency of soft skills in their professional activities. Participants were also asked to rank the soft skills in a crescent order of importance. The sample was divided into subgroups: A) residents in Orthodontics; B) orthodontists with less than 5 years of experience and C) orthodontists with more than 5 years of experience. Intergroup comparisons were performed using the Kruskal-Wallis test. Sexual differences were compared using Mann-Whitney test (p< 0.05). Results: The sample of this observational study comprised 129 experienced orthodontists and residents in Orthodontics (92 women, 37 men) with mean age of 35.3 years. From the total sample, 54,6% of respondents reported no previous instructions on soft skills. All respondents reported using the analyzed soft skills with a similar frequency (median 4-5). Residents reported accessing reliable sources in bibliographic research less frequently (46%). Female orthodontists reported to seek help from teachers and other professionals more often than males. Ethics and communication were frequently ranked as the most important soft skills. Information management and leadership were frequently less ranked as important soft skills. Conclusion: Poor knowledge of soft skills was demonstrated by residents and orthodontists. Communication skill was highly used and frequently ranked as the most important soft skill.


INTRODUCTION
Globalization has changed the references of interaction and relationship patterns between people. 1 Health professionals should be trained not only in technical and scientific skills, but also in social skills. 1 The educational institutions in Dentistry already grant their students great cognitive and psychomotor attributes.However, there has been a worldwide educational movement that values instructions of non-cognitive tools related to emotional intelligence. 2ft skills are a range of personal skills, characteristics, and attitudes that represent key factors for success at work and in academic environments. 3Soft skills are related to better professional performance and can be improved with training. 4 Dentistry, characteristics such as communication, professionalism and good coordination of the work team increase patient reliability in the professional work, and increase the success of clinical practices. 5The main soft skills addressed in higher education programs in Dentistry are communication, critical thinking, teamwork, leadership and professionalism.Recent studies reveal that soft skills have been addressed within Dentistry education around the globe. 3,7,8UK researchers defend assessing soft skills and sensorimotor skills as part of the selection for students who intend to be dentists. 7Dentistry residents from Pakistan have recognized the importance of soft skills in their profession, even though leadership was not considered important. 8Undergraduate students from Malaysia considered teamwork and communication the most relevant skills. 9In Iran, the soft skills considered relevant by undergraduate students were professional ethics, artistic skills (manual skill and esthetic vision) and cognitive skills (creativity, critical sense and decision-making). 3From a work perspective, the use of non-technical skills is associated with greater employability and better clinical outcomes. 9 previous study has evaluated the influence of soft skills in the orthodontic field.This study aimed to assess the knowledge, usage, and importance priority of soft skills by both orthodontists and residents in Orthodontics.Volunteers, represented by orthodontists and residents in orthodontics, were invited to answer an online questionnaire with 34 questions using Google Forms.The questionnaire (Fig 1) explored nine soft skills relevant to Dentistry, according to the scientific literature. 3,8The soft skills included were communication, teamwork, critical thinking, problem-solving, creativity, leadership, professional ethics, learning and information management.

This study was approved by the Ethics in
In the first part of the questionnaire, through a Likert scale (never, rarely, sometimes, almost always, always), participants answered the frequency that they performed or were aware of soft skills in professional activities.Secondly, respondents were asked to rank the importance of nine soft skills.The participants ranked the soft skills from one to nine, according to their personal order of importance, in which one was the least important and nine, the most important.
The sample calculation for this study was based on the sample size of a previous cross-sectional research 8 that aimed to develop a soft skills questionnaire for 60 Dentistry students.
The Google forms were sent to orthodontists and residents in orthodontics, using WhatsApp.The contact of the dentists was collected through a list of 1 688 professionals and residents from the Brazilian Association of Orthodontics.

STATISTICAL ANALYSIS
The frequencies of the Likert scale were converted into a numerical order, from one (never) to five (always), for statistical purposes.In the ranking process, the sum of all the numbers selected by the participants for each soft skill was calculated.
The skills with the lowest total value were the less important, while the ones that presented the highest values in the total sum were considered more important.
Intergroup comparison was performed using Kruskal-Wallis tests.A post-hoc pairwise comparison was also performed in case of statistical difference.Mann-Whitney U test was used to compare sexes.Data analysis was carried out using the JAMOVI 2) open-source statistical software (https://www.jamovi.org).Results were considered significant at p<0.05.

RESULTS
Descriptive statistics of the sample are described in Table 1.
The absolute and relative frequencies of all groups are described in Table 2 their training (Table 2).Respondents also frequently reported getting along well with patients and their parents with high frequency (average of 64% and 57%, respectively).
In addition, acting professionally with responsibility and flexibility with teamwork were frequently reported (average of 72%, 73% and 81%).Both men and women showed similar findings, except for question #11 (p = 0.005).Women demonstrated seeking support from professors and colleagues more often than men (Table 4).

DISCUSSION
This is the first study to investigate the use and application of soft skills in Orthodontics.Soft skills are subjective abilities that act in the behavioral and social spectrum of human beings. 5The enhancement of emotional abilities has been described as an important factor in improving academic performance and interpersonal relationships with members of the academic community. 4,9The enhancement of soft skills is directly related to the development of emotional intelligence. 10High levels of emotional intelligence are also related to a mutual improvement in the dentist-patient relationship. 6,11Healthcare providers showed better working management strategies, more empathy, and also meeting patient expectations more often when they develop their emotional intelligence. 12Additionally, patients are less anxious, more adherent to treatment, and more faithful to dentists with higher levels of emotional intelligence. 6e present results demonstrated that 54,6% of orthodontists have not received any instructions on soft skills during their professional training.However, the soft skills were frequently used in their daily practice.These findings indicated that dental schools focus their efforts on the theoretical and technical training of residents in orthodontics. 1Recent efforts to broaden the debate on emotional abilities in universities were performed. 13wever, there is still a worldwide deficit of attention to soft skills in the academic curriculum.Interestingly, residents demonstrated to access reliable research sources less frequently than young orthodontists.Self-guided education in adults is related to characteristics such as maturity, responsibility, and previous experiences. 13Consequently, residents in Orthodontics may still present some difficulties accessing reliable research sources, since they have not been exposed to similar circumstances with the same frequency.
In addition, women reported to seek help from other professionals more often than men.These findings agree with the literature, in which female dentists tended to be more conservative in their treatments, refer patients more frequently, and use their communication skills more often and more effectively than men. 14,15One limitation of the present study was the sex distribution among the participants.A greater number of women answered the questionnaire, when compared to men (92 women and 37 men).This phenomenon may be associated with the current feminization trend in Dentistry.An increase in the active participation of women in Dentistry has been observed in the last decades. 14,15The increase in the proportion of women in Dentistry caused changes in working patterns and career satisfaction. 16Although the profession may shift toward less entrepreneurship to more urbanization, feminization in Dentistry is associated with more empathy, communicative and preventive strategies.Among all listed soft skills, ethics and communication were more frequently ranked as the most important ones.Although undergraduate curricula include theoretical instruction regarding the legal aspect of Dentistry, it is also important to provide students with clinical skills as well. 17Ethics can be considered a concern for orthodontists, since they often face ethical issues in their daily practice. 18It is important that these professionals use their communicative skills, informing properly the patient about treatment, procedures and factors that may interfere with the professional's ability to obtain a more favorable prognosis. 19The patient must sign a dental service contract and informed consent form, agreeing with the treatment plan, and be aware of all possible incidents and limitations. 19mmunication has been the most studied and mentioned soft skill in the literature. 20Understanding communication in its different forms is fundamental to dealing with the demands of patients and their anxieties. 20,21Effective communication is associated with lower levels of stress, better patient adherence and loyalty, and reduced professional negligence. 22On the other hand, lack of communication skills is associated with difficulties in the relationship with patients and with significant unemployment rates. 20,21 ntal Press J Orthod.2024;29(2):e242370 Among all listed soft skills, information management and leadership were less frequently ranked as important skills.
The analysis of the dentist-patient relationship and its effectiveness has been directed towards more empathic and less paternalistic bonds. 23Therefore, even if a professional hierarchy is necessary, there is a tendency towards an egalitarian relationship where the dentist is not placed as a leader, but as a partner during treatment, health improvement and quality of the patient's life.However, residents should be better trained regarding leadership skills related to teamwork.When defining characteristics of financially successful orthodontists, leadership is mentioned for maximizing talents and teamwork, in order to provide exemplary patient care and attain increased levels of production. 24recent resolution by the Brazilian Ministry of Education highlighted the importance of some of the soft skills for Dentistry graduate education. 25

Silva I ,
Miranda F, Lauris JRP, Garib D -Soft skills in Orthodontics: an analysis in residents and experienced professionals Dental Press J Orthod.2024;29(2):e242370 Professional ethics and communication were most frequently ranked as important soft skills (Fig 2).Information management and leadership were less frequently considered important soft skills (Fig 2).The following descending order of importance was found for the nine skills: professional ethics, communication, problem-solving, learning, teamwork, critical thinking, creativity, information management and leadership.
New curriculum guidelines were recommended, directing efforts towards development, especially in communication and leadership skills.Although leadership skill was highlighted by competent educational institutions, it was one of those considered least important by the participants of this research.In general, it is important to see the discourse of soft skills reaching political-educational dimensions around the world.Dental Press J Orthod.2024;29(2):e242370 All research participants were from the same institution, and this is a limitation, since the use of soft skills may vary according to cultural and behavioral aspects. 2 Due to the low response rate of the data collected by the research, the consequent results should be considered with caution, and not generalized, as the respondents represent only a portion of this population.However, it is important to highlight the originality and uniqueness of this first analysis for the orthodontic field.Further multicentric studies should be performed, with a larger sample and evaluating new generations of orthodontists.Evaluation of the influence of soft skills on patient collaboration with removable orthodontic appliances and oral hygiene should also be performed.Dental Press J Orthod.2024;29(2):e242370 CONCLUSION Conclusions are representative of the sampled population within the presented context.Residents in Orthodontics and experienced orthodontists had not received any training regarding soft skills.Newly graduated orthodontists were more frequently able to search and access reliable sources of information than residents in Orthodontics.Women demonstrated seeking professional help more often than men.Ethics and communication were more frequently ranked as the most important skills in professional life.Information management and leadership were less frequently ranked as important skills.

Soft skills in Orthodontics: an analysis in residents and experienced professionals 10 Dental
Press J Orthod.2024;29(2):e242370

Table 2 :
Absolute and relative frequencies.

Table 4 :
Comparison of answers between the sexes (Mann-Whitney U test).